32C-206 (8) For the pantry on the first floor.
• To finish installing the sheetrock, after the framing is completed.
• The pantry will receive a three coat tape job
• The sheetrock will be sanded.
For the second floor walls and ceilings
* To install 1/2" sheetrock over the wood lathing after the plaster is
removed by the owner.
• The new sheetrock will receive a three coat tape job
• The ceilings and the walls will be sanded.
• Any openings wrapped with sheetrock and corner bead instead of wood
casings will be done for an extra charge of $ 90.00 per opening.
* The owner will be responsible for, finishing the framing in the pantry
on the first floor, covering the existing floor finish on the second
floor and removing the plaster on the second floor, before the job is
started. If you would like help with these areas of the project please
contact us for additional pricing.
Please Note:
Once the proposal is signed the project will go into the job schedule
and you will be given an approximate start date. This date can fluctuate
based on the time involved to complete the projects entered into the
schedule before you. Two days before the actual start of the project you
will be notified by phone. This project will take approximately 12-14
days to complete.
The rooms to be worked in will need to be totally cleaned out and the
ceiling and wall fixtures removed before the work can begin.
Any areas not ready with the rest of the job, requiring extra trips to
the job by any of the crews, will be charged as an extra.
When covering and protecting the existing finishes there is always a
possibility that the finishes will be damaged by the masking tape we
accept no responsibility if this damage should occur, please sign the
disclaimer below.
DISCLAIMER:
We do not hold N. R. Bergeron Drywall Contractor, Inc. or its employees
or representatives liable for any damage to the existing finishes.
SIGNATURE DATE
RIGHT OF CANCELLATION:
Do not sign this section unless you want to cancel this proposal.
You have the right to cancel this contract at any time with in three
days of the signing date. To cancel phone notification is requested,
followed by the returning of your copy of the proposal signed and dated
below.
SIGNATURE DATE
2
N.R. BERGERON
DRYWALL CONTRACTOR, INC.
1106 EAST MOUNTAIN ROAD
WESTFIELD MASSACHUSETTS 01085
PHONE: (413)568-0962
MA HIC #: 1037�j1'8 CT HIC #: 603077
PROPOSAL SUBMITTED TO 1I( //0 PHONE DATE
Larry Brotherton 413-695-7199 06/03/2009
STREET CITY STATE ZIP
1 Kary Street Northampton MA 01060
JOB NAME: 2nd floor walls and ceilings
JOB LOCATION: Same address as listed above.
WE PROPOSE TO FURNISH MATERIALS AND LABOR FOR THE SUM OF:
Three thousand five hundred twenty dollars ($3,520.00)
PAYMENT TO BE MADE AS FOLLOWS: All invoices are due and payable upon receipt.
50% when the materials are ordered $1, 760. 00, 20% when the hanging is
started $704 .00, 20% when the taping is started $704 .00, 10% when the
project is completed $352.00.
All material is guaranteed to be as specified. All work will be completed in a workmanlike manner
according to standard practices.Any alterations or deviations from the specifications listed below
involving extra costs will be executed only upon written change orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents or delays
beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are
fully covered by Workman's Compensation Insurance.
This price is guaranteed for a period of thirty days, except as noted below, after that time any
changes in material costs or labor costs will automatically to be added to the estimate.
All invoices are due and payable upon receipt. Any missed payments will constitute a reason for
stopping the work on the project.
Any balance remaining unpaid 30 days after the billing date will be subject to a service charge of 1
1/2 % per month.
In the event of default or non-payment you hereby agree to pay all reasonable costs of collection
including, but not limited to, all attorneys fees and expenses.
AUTHORIZED SIGNATURE: &116tejA.Xft
DESCRIPTION OF WORK:
The description of all work to be performed under the proposal is listed
on page 2. Please see page 2.
ACCEPTANCE OF PROPOSAL: The prices, specifications and conditions
set forth in this proposal are satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payment will be made as
specified above.
SIGNATURE DATE
SIGNATURE DATE
Please sign and return one copy.
Thank you for the opportunity to do your work.
DESCRIPTION OF WORK:
1
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s)who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfigh
sonotube holes (before pour) a rough building inspection (before work is
concealed), insulation inspection (if required)and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing&gas)the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections.Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date 'r q
Address of work
location - .�
lov
r> The Commonwealth of Massachusetts
Department of Industrial Accidents
Office bf Iizvestigations
�. 600 f1'ashington Street
Boston, MA 02111
www.tnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
f ?
Name(Business/Organization/Individual): _
Address: b:: —P
City/State/Zip: Phone#: QI Li
Are you an employer?Check the appropri to bon: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working or me in an capacity. employees and have workers'
g y p t5'- 9. ❑ Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions
3'�X I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs.
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
,Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided(!/,/above is true and correct.
Signature Date: �l /(1 ea
Phone#- �/ / / !
Of use only. Do not write in this area, to be completed by city or town official
Citv or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9. Regisrtered'Horhe Im6rovern6 Fact Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§'256(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
11. Home Dvnerzge � on'
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition-Section 108.3.5.1_
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature ��
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Siding[E-1] Other[O]
Brief Description of Proposed
Work: ��^c��r
Alteration of existing bedroom Yes 64 No Adding new bedroom Yes X No of
Attached Narrative Renovating unfinished basement Yes No
x
Plans Attached Roll -Sheet
6a. If New house and or.addition to-existinq housing;complete the following:
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? psclscck or odstoves Number of each
g. Energy Conservation Compliance. Mass rgy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? nstruction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below fik. Will building conform to the Building and Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT
1 as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereb eclare that t statem nts and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
I
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
LotSize __._,. . ,,,,._... ......... ......_. .,._...__,.,....
Frontage
Setbacks Front
Side L:<._. ,_,_ : R. _.,._. _. L R:,-,
Rear
Building Height
Bldg. Square Footage %
Open Space Footage ° -°°--
(Lot area minus bldg&paved
parkin
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/'on the site?
NO 0 DONT KNOW YES
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Nofthampton Storm Water Management Permit from the DPW is required.
Department use only,
City of Northampton Statue of Permit
Building Department Cuib Cu#tr1 ewayPerrntt M
212 Main Street SevirerlSeptrcAvaitabtltty
Room 100 WateriUlrell.AyalfaJ7�I�ty k
Northampton, MA 01060 Twa Sets of S#ructt rat Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Sr#e PJans-
Ot)er�peafy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
' Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT'
2.1 Owner of Record:
- I �
t
Name(Pr Current Mailin g Add�reDs2 A 7
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
1
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building 100 I, (a)Building Permit Fee
2. Electrical V (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building'Permit'Fee
4. Mechanical(HVAC)
5. Fire Piulecliun
6. Total=(1 +2+3+4+:5 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-1048
APPLICANT/CONTACT PERSON SCHIFFER ELYENA
ADDRESS/PHONE 1 KARY ST NORTHAMPTON (914)629-2764 Q
PROPERTY LOCATION 1 KARY ST
MAP 32C PARCEL 206 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE PLASTER IN 2 ROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION PRESENTED: N66b5- P6rz ,i �Q1MEr�W D ���- SNE TRH
L Approved Additional permits required(see below) C-A �1
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
06 23o2
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
'I VAR BP-2009-1048
#' GIs#: COMMONWEALTH OF MASSACHUSETTS
m 12-2 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-1048
Protect# JS-2009-001519
Est.Cost: $1000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NR BERGERON DRYWALL CONTRACTOR INC 103718
Lot Size(sq.ft.): 3702.60 Owner: SCHIFFER ELYENA
Zoning URC(100)/ Applicant: SCHIFFER ELYENA
AT. 1 KARY ST
Applicant Address: Phone: Insurance:
1 KARY ST (914) 629-2764 O
NORTHAM PTONMA01 060 ISSUED ON:612312009 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE PLASTER IN 2 ROOMS ENLARGE
BATHROOM & CLOSET
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Date Paid: Amount:
Building 6/23/2009 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo